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Transmission/Prevention

Section Three

Transmission/Prevention

Hepatitis C is transmitted by blood-to-blood contact. Any break in the skin may allow HCV to enter the body, even if no blood is visible.

The most common transmission route for hepatitis C is through sharing needles and other equipment for injecting drugs (cookers, tourniquets, cottons, water, etc.). Certain non-injection drug paraphernalia (crack pipes or straws used for snorting drugs, for example) also pose a risk of transmission.

Before 1992, when a reliable blood test to identify HCV antibodies became available, many people contracted hepatitis C through blood or blood product transfusions. Since then, the blood supply has been screened, and today the risk of HCV transmission via transfusion is very low—less than one case per 2 million units of transfused blood. However, there have been some recent cases of HCV transmission in medical facilities due to inappropriate reuse or improper cleaning of items such as endoscopy equipment.

The risk of sexual transmission of HCV is not entirely clear. Only a small percentage (estimated at 1%–3%) of monogamous heterosexual couples in stable long-term relationships contract hepatitis C through unprotected sexual activity. The risk is higher, however, for people in so-called “high risk” groups, including men who have sex with men, sex workers, people with multiple sex partners, and people with sexually transmitted diseases. In recent years, outbreaks of sexually transmitted acute HCV infection have been reported in several European, Australian and U.S. cities among HIV positive gay and bisexual men with no traditional risk factors.

Healthcare workers and emergency responders are at risk for HCV infection due to needlestick accidents and unavoidable situations that may result in direct contact with blood from an infected individual.

Perinatal transmission from HCV-infected pregnant women to their infants before or during birth occurs about 6% of the time. Whether or not transmission occurs may depend on the amount of HCV in the mother’s blood; women who are coinfected with HIV are more likely to transmit HCV to their babies. Some studies have shown that small amounts of HCV may be present in breast milk, but breastfeeding is considered safe.

Needles used for tattooing, body piercing, and acupuncture may also spread HCV. Sharing personal items such as razors, toothbrushes, or nail files is a less likely, but possible, transmission route.

The transmission route for up to 10% of individuals with hepatitis C cannot be determined. HCV is not transmitted by casual contact such as sneezing, coughing, hugging, or sharing eating utensils and drinking glasses.

Prevention

In most cases, HCV transmission can be prevented by taking appropriate precautions such as avoiding any item that might contain or come in contact with blood.

Do not share needles or any other drug paraphernalia (works-cookers, cottons, ties, water etc).

The risk of transmitting hepatitis C through sex for people in stable, long- term monogamous relationships appears to be very uncommon—partners should discuss safer sex options if either is concerned about transmission. You can reduce the risk of sexual transmission of HCV by practicing safer sex, including the use of condoms, gloves and other barriers. HCV does not seem to be transmitted in semen, but rather through “rough sex” and activities that involve contact with blood. People who are not in such a relationship can take precautions to avoid contact with blood and other body fluids during sex.

Proper dental hygiene can prevent bleeding gums, another potential HCV transmission route. Avoid sharing razors, toothbrushes, clippers, nail files, or any other items that may come in contact with blood.

Make sure that instruments used for tattooing, body piercing, acupuncture, and medical procedures are properly sterilized; practitioners today should only use disposable needles. Cover all cuts and wounds with a bandage.

Notify your doctor, dentist, and other healthcare providers if you have HCV. Healthcare workers and emergency personnel should observe standard universal precautions when dealing with blood. If you are a woman with HCV, talk to your doctor if you are thinking about becoming pregnant.

Facts

The hepatitis C virus can live outside the body for up to 6 weeks

Do not share (or reuse on a different person) any item that might contain or come in contact with blood

Bleach has been found to kill the hepatitis C virus, but it is unknown if it will kill it inside a syringe—never share any drug, vitamin or steroid equipment or any other item that has or may have blood on it

Sexual transmission among people in a stable monogamous relationship is considered uncommon. The risk can be reduced by practicing safer sex